title: Acute cellular and antibody-mediated rejection of the pancreas allograft: incidence, risk factors and outcomes.
abstract: Antibody-mediated rejection (AMR) after pancreas transplantation is a recently identified entity. We describe the incidence of, risk factors for, and outcomes after AMR, and the correlation of C4d immunostaining and donor-specific antibody (DSA) in the diagnosis of AMR. We retrospectively analyzed 162 pancreas transplants in 159 patients who underwent 94 pancreas allograft biopsies between 2006 and 2009. Univariate and multivariate analyses were performed to evaluate risk factors for pancreas graft AMR. One-year rejection rates and survival after rejection were calculated by Kaplan-Meier methods. AMR occurred in 10% of patients by 1-year posttransplant. Multivariate risk factors identified for AMR include nonprimary simultaneous pancreas-kidney (SPK) transplant, primary solitary pancreas (PAN) transplant and race mismatch. After pancreas rejection, patient survival was 100% but 20% (8 of 41) of pancreas grafts failed within 1 year. Graft survival after acute cellular rejection (ACR), AMR and mixed rejection was similar. Of biopsies that stained >5% C4d, 80% were associated with increased Class I DSA. In summary, AMR occurs at a measurable rate after pancreas transplantation, and the diagnosis should be actively sought using C4d staining and DSA levels in patients with graft dysfunction, especially after nonprimary SPK and primary PAN transplantation.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
authors.forename: S V
authors.initials: SV
authors.lastname: Niederhaus
authors.forename: G E
authors.initials: GE
authors.lastname: Leverson
authors.forename: D F
authors.initials: DF
authors.lastname: Lorentzen
authors.forename: D J
authors.initials: DJ
authors.lastname: Robillard
authors.forename: H W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: J D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: J R
authors.initials: JR
authors.lastname: Torrealba
authors.forename: J S
authors.initials: JS
authors.lastname: Odorico
mesh_terms: D000328:Adult; D064591:Allografts; D015935:Complement C4b / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology*; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010446:Peptide Fragments / Q000276:immunology; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
keywords: Antibody-mediated rejection; biopsy; cellular rejection; donor-specific antibody; kidney transplantation; outcomes; pancreas transplantation